Birth plan template

mrsk2005 · January 2010

Does anyone have a link to a good birth plan template? I can't find the one I used with DD but wanted to make sure I get how I want my birthing process to go down in writing for the hospital staff. TIA!

1momma · January 2010

Thebump has one, under pregnancy tools.

maple669 · January 2010

I picked and chose from multiple birth plan templates to create a one page birth plan that addresses all my most important issues...i found that not one of them was 100% good enough

maple669 · January 2010

Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Here is my birth plan...i pasted it from word.

Birth Preferences: _________(name)
Due Date: ___________ ? _________ OB/GYN ?

Spouse: ______________ ? Doula: _____________

Labor

I would appreciate being assigned a nurse who enjoys natural births
I wish to be able to change position at will throughout labor.
I would like to be able to eat and drink as I desire.
I would like the lights in the room to be kept low during my labor.
I would appreciate a minimum of vaginal exams and only to be done by nurses or doctors. Please allow 3-4 hours between each centimeter dilation before declaring "stalled progress".
Please no IV or Saline-Lock unless absolutely necessary.

Monitoring

I would prefer intermittent fetal monitoring as opposed to continuous fetal monitoring; as required by the condition of baby.
I wish to avoid an internal monitor unless absolutely necessary.

Labor Augmentation/Induction

I do not wish to have the amniotic membrane ruptured artificially.
I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before artificial induction is suggested or insisted upon.

Pain Medication/ Pain Relief

I realize that many pain medications exist. I'll ask for them if I need them. I do not wish to have these offered to me.
I'd like to manage my pain naturally through the bath and showers; and would appreciate coaching as needed for using the birthing ball, spousal massage, and ice/heat packs as required.
Please refrain from any medical interventions not previously agreed upon. I am happy to discuss any measures which may be deemed medically necessary prior to their implementations

Cesarean

I would like to avoid a Cesarean unless absolutely necessary and would prefer to try alternatives to cesarean without pressure.
If a Cesarean delivery becomes necessary, I would like to be fully informed and to participate in the decision-making process with my spouse present at all times.

Episiotomy

I do not want an episiotomy and wish to protect the perineum, I would prefer a natural tear...but I am willing to discuss this should the need arise.
I am practicing ahead of time by squatting, doing Kegel exercises and perineal massage. I would appreciate guidance in when to push and when to stop pushing to allow the perineum to stretch.

Delivery

I would like to be allowed to choose the position in which I give birth, including squatting, on hands and knees etc.
Even if I am fully dilated, and assuming baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
I would appreciate the room lights turned low for the delivery.
I would like to have baby placed on my stomach/chest immediately after delivery as long as baby is okay.

Immediately After Delivery / Postpartum

Please allow the umbilical cord to stop pulsating before it is cut. I would like my spouse to be offered the option to cut the cord.
I would like to hold baby while I deliver the placenta and any tissue repairs are made.
I would like to have baby evaluated and bathed in my presence or my spouse's presence.
If baby must be taken from me to receive medical treatment, my spouse will accompany baby at all times.
I appreciate your patience in waiting for the placenta to detach naturally...I do not want a routine injection of Pitocin after the delivery to aid in expelling the placenta, unless absolutely necessary (as long as there is no heavy bleeding).
I'd like to delay baby's eye medication for a few hours after birth.
I do not wish to have the baby injected with Hepatitis B vaccine.
Unless required for health reasons, I do not wish to be separated from my baby.

Breastfeeding

I plan to breastfeed baby and would like to begin nursing very shortly after birth.
I would like to meet with the staff Lactation Consultant as soon as possible following birth to assess breastfeeding progress.
I do not wish to have any bottles (including glucose water or plain water) or pacifiers given to baby.

Iheartkevi · January 2010

I used birthplan.com, then copied and pasted into a word document, took out the headings, and shortened a lot of the sentences. My birthing instructor recommended that it not be longer than one typed page and not too small of a font or most medical staff won't take the time to read it.

maple669 · January 2010

It didn't copy perfectly...but i have it bulleted and set up in two columns on one page in word...i felt it was best to keep it all on one side of a page!

Jennrs · January 2010

Birth plan for _________ and ________

Care provider:

Our desire is to have a natural, non-medicated and intervention free birth. We fully appreciate your support in our decision.

Labor

Would like to be able to move around often
Intermittent fetal monitoring
Would like to be able to eat and drink
Do not want an I.V.
Would like the option to labor in any position I feel comfortable (i.e. birth ball, shower/tub, all fours, etc...)
Would like to keep vaginal exams to a minimum
Please do not offer me any pain medication

Birth

Please assist with counter pressure, positioning, warm compresses, and KY jelly
Would like a quiet and peaceful room, with dim lights
Do not want an episiotomy
Please encourage me to stay off my back?prefer to be on all fours or squatting
Do not want forceps or a vacuum to be used
Would like the baby placed on my chest immediately after birth
Please wait to cut the cord until it stops pulsing ?My husband would like to cut the cord
I will breastfeed my baby as I deliver the placenta?do not administer a pitocin shot unless absolutely necessary

After Delivery

No eye medication

Do not want hepatitis B shot administered immediately after birth
Vitamin K shot for baby boy only
Baby boy will be circumcised
We will room-in with our baby
Please wait to bathe baby
I will be breastfeeding; please do not offer pacifiers or bottles
If baby needs medical attention one of us will always be present

Cesarean Section

Jake will be present at all times
I would like one hand free
Would like immediate contact with baby, if possible
Please double suture incision

Thank you for understanding; we know that you will do everything possible to make our stay in the hospital a pleasant one!

AmandaToo · January 2010

I liked the advice here:

https://nursingbirth.com/2009/07/23/top-ten-dos-for-writing-your-birth-plan-tips-from-an-ld-nurse-part-2/

Birth plan template

Re: Birth plan template

Choose Another Board

Search Boards